A mutação recorrente JAK2V617F é a lesão molecular com maior impacto na fisiopatologia das neoplasias mieloproliferativas (NMP) BCR ABL1 negativas. A ausência de resposta clínica completa ao inibidor seletivo de JAK1/2, ruxolitinibe, indica a necessidade de novas abordagens terapêuticas. Dados recentes sugerem que IGF1R/IRS representa um potencial alvo de inibição para o tratamento das NMP: (i) o substrato do receptor de insulina 2 (IRS2) coopera com JAK2V617F na transformação maligna em NMP; (ii) a desregulação da via de sinalização de IGF1R induz NMP. O composto NT157 foi desenvolvido para inibir IRS1/2 e apresentou efeitos antineoplásicos em neoplasias sólidas. Os objetivos deste trabalho foram avaliar os efeitos celulares e moleculares do tratamento com o inibidor de IRS1/2, NT157, isolado e em combinação com ruxolitinibe, em NMP JAK2V617F. Células HEL e SET2 JAK2V617F foram tratadas com veículo, NT157 e/ou ruxolitinibe e submetidas à avaliação da viabilidade celular, apoptose, proliferação, clonogenicidade, ciclo celular, expressão gênica e/ou expressão/ativação proteica. Células primárias de pacientes com policitemia vera foram submetidos a tratamento com NT157 e avaliação de formação espontânea de colônias eritroides. O efeito do NT157 in vivo foi avaliado utilizando modelo de xenotransplante de células HEL em camundongos NSG. A análise estatística foi realizada através do teste ANOVA ou t de Student. Em células HEL e/ou SET2 JAK2V617F, o tratamento com NT157 promoveu redução da viabilidade, clonogenicidade e proliferação celular, aumentou a apoptose e resultou em parada do ciclo celular em G2/M (p?0,05). Exposição ao NT157 resultou em inibição da fosforilação de STAT3, STAT5 e ERK e na modulação da expressão de 23 oncogenes (CCND1, MYB e WT1) e genes supressores tumorais (CDKN1A, JUN e FOS) em células HEL (p?0,05). O tratamento combinado com ruxolitinibe não apresentou efeito potencializador, sendo que a redução da viabilidade nas condições de combinação corresponde ao efeito das monoterapias nas linhagens celulares avaliadas. Em células primárias de pacientes com policitemia vera (n=3), NT157 reduziu a formação espontânea de colônias eritroides (p?0,05). O tratamento in vivo com veículo ou NT157 na dose de 70mg/kg, 3 vezes por semana, via intraperitoneal, em modelos de xenotransplante com células HEL em camundongos NSG (n=5 para cada grupo) não apresentou efeitos antineoplásicos. Em conclusão, a inibição farmacológica de IRS1/2 apresentou efeitos antineoplásicos significativos em modelos de linhagens celulares e amostras primárias de pacientes com NMP JAK2V617F. A inibição farmacológica combinada de IRS1/2 e JAK1/2 não potencializou o efeito antineoplásico das monoterapias nos processos celulares investigados. Os resultados dos estudos in vivo em modelos de xenotransplante indicam a necessidade de estudos de farmacocinética e farmacodinâmica para o NT157. Os efeitos moleculares identificados permitiram uma melhor compreensão sobre os mecanismos de ação da droga NT157 em NMP. / The recurrent V617F mutation in JAK2 is a major contributor to the pathogenesis of BCR-ABL1 negative myeloproliferative neoplasms (MPN). Absence of complete clinical response to ruxolitinib, a JAK1/2 inhibitor, highlights the need for targeting other signaling pathways that contribute to JAK2. Recent data indicate that IGF1R/IRS is a potential target in MPN: (i) insulin receptor substrate 2 (IRS2) cooperates to malignant transformation induced by JAK2V617F, (ii) IGF1R signaling upregulation induces MNP phenotype. NT157 is a synthetic compound designed as IRS1/2 inhibitor and was able to induce anti-neoplastic effects in solid tumors. We, herein, aimed to characterize the molecular and cellular effects of NT157 treatment, combined or not with ruxolitinib, in MPN JAK2V617F. HEL and SET2 JAK2V617F cells were treated or not with vehicle, NT157 and/or ruxolitinib and submitted to evaluation of cell viability assay, apoptosis, proliferation, clonogenicity, cell cycle, gene expression and protein expression/activation. Primary cells from polycythemia vera (PV) patients (n=3) were exposed to NT157 treatment and evaluated for erythropoietin-independent colony formation. NT157 effects in vivo were evaluated in a xenograft model of leukemogenesis induced by HEL cells in NSG mice. Statistical analysis was performed using ANOVA or Student\'s t test. In MPN cell lines, NT157 treatment significantly decreased cell viability, clonogenicity and cell proliferation, increased apoptosis and cell cycle arrest in G2/M (all p<0.05). NT157 exposure resulted in inhibition of STAT3, STAT5 and ERK phosphorylation. NT157 also modulated the expression of 23 oncogenes (CCND1, MYB and WT1) and suppressor tumor genes (CDKN1A, FOS and JUN) in HEL cells (p?0.05). In both cell lines, the combined treatment, NT157 plus ruxolitinib, did not potentiate the effects of monotherapies. In primary cells from polycythemia vera patients, NT157 exposition reduced spontaneous erythroid colony formation (all p<0.05). In vivo treatment with vehicle or NT157 (70mg/kg intraperitoneal), three times a week, showed no antineoplastic effects in NSG mice transplanted with HEL cells (n = 5 for each group). In summary, the IRS1/2 pharmacological inhibitor NT157 displayed remarkable antineoplastic effects in JAK2V617F cells lines and MPN primary cells. The combined treatment of NT157 plus ruxolitinib did not present potentializing effects when compared to the monotherapy. The results of in vivo treatment using a xenograft model highlight the need for pharmacokinetic and pharmacodynamic studies for the NT157 compound. The molecular effects identified allowed a better understanding about the mechanisms of NT157 action in MPNs.

A mutação recorrente JAK2V617F é a lesão molecular com maior impacto na fisiopatologia das neoplasias mieloproliferativas (NMP) BCR ABL1 negativas. A ausência de resposta clínica completa ao inibidor seletivo de JAK1/2, ruxolitinibe, indica a necessidade de novas abordagens terapêuticas. Dados recentes sugerem que IGF1R/IRS representa um potencial alvo de inibição para o tratamento das NMP: (i) o substrato do receptor de insulina 2 (IRS2) coopera com JAK2V617F na transformação maligna em NMP; (ii) a desregulação da via de sinalização de IGF1R induz NMP. O composto NT157 foi desenvolvido para inibir IRS1/2 e apresentou efeitos antineoplásicos em neoplasias sólidas. Os objetivos deste trabalho foram avaliar os efeitos celulares e moleculares do tratamento com o inibidor de IRS1/2, NT157, isolado e em combinação com ruxolitinibe, em NMP JAK2V617F. Células HEL e SET2 JAK2V617F foram tratadas com veículo, NT157 e/ou ruxolitinibe e submetidas à avaliação da viabilidade celular, apoptose, proliferação, clonogenicidade, ciclo celular, expressão gênica e/ou expressão/ativação proteica. Células primárias de pacientes com policitemia vera foram submetidos a tratamento com NT157 e avaliação de formação espontânea de colônias eritroides. O efeito do NT157 in vivo foi avaliado utilizando modelo de xenotransplante de células HEL em camundongos NSG. A análise estatística foi realizada através do teste ANOVA ou t de Student. Em células HEL e/ou SET2 JAK2V617F, o tratamento com NT157 promoveu redução da viabilidade, clonogenicidade e proliferação celular, aumentou a apoptose e resultou em parada do ciclo celular em G2/M (p?0,05). Exposição ao NT157 resultou em inibição da fosforilação de STAT3, STAT5 e ERK e na modulação da expressão de 23 oncogenes (CCND1, MYB e WT1) e genes supressores tumorais (CDKN1A, JUN e FOS) em células HEL (p?0,05). O tratamento combinado com ruxolitinibe não apresentou efeito potencializador, sendo que a redução da viabilidade nas condições de combinação corresponde ao efeito das monoterapias nas linhagens celulares avaliadas. Em células primárias de pacientes com policitemia vera (n=3), NT157 reduziu a formação espontânea de colônias eritroides (p?0,05). O tratamento in vivo com veículo ou NT157 na dose de 70mg/kg, 3 vezes por semana, via intraperitoneal, em modelos de xenotransplante com células HEL em camundongos NSG (n=5 para cada grupo) não apresentou efeitos antineoplásicos. Em conclusão, a inibição farmacológica de IRS1/2 apresentou efeitos antineoplásicos significativos em modelos de linhagens celulares e amostras primárias de pacientes com NMP JAK2V617F. A inibição farmacológica combinada de IRS1/2 e JAK1/2 não potencializou o efeito antineoplásico das monoterapias nos processos celulares investigados. Os resultados dos estudos in vivo em modelos de xenotransplante indicam a necessidade de estudos de farmacocinética e farmacodinâmica para o NT157. Os efeitos moleculares identificados permitiram uma melhor compreensão sobre os mecanismos de ação da droga NT157 em NMP. / The recurrent V617F mutation in JAK2 is a major contributor to the pathogenesis of BCR-ABL1 negative myeloproliferative neoplasms (MPN). Absence of complete clinical response to ruxolitinib, a JAK1/2 inhibitor, highlights the need for targeting other signaling pathways that contribute to JAK2. Recent data indicate that IGF1R/IRS is a potential target in MPN: (i) insulin receptor substrate 2 (IRS2) cooperates to malignant transformation induced by JAK2V617F, (ii) IGF1R signaling upregulation induces MNP phenotype. NT157 is a synthetic compound designed as IRS1/2 inhibitor and was able to induce anti-neoplastic effects in solid tumors. We, herein, aimed to characterize the molecular and cellular effects of NT157 treatment, combined or not with ruxolitinib, in MPN JAK2V617F. HEL and SET2 JAK2V617F cells were treated or not with vehicle, NT157 and/or ruxolitinib and submitted to evaluation of cell viability assay, apoptosis, proliferation, clonogenicity, cell cycle, gene expression and protein expression/activation. Primary cells from polycythemia vera (PV) patients (n=3) were exposed to NT157 treatment and evaluated for erythropoietin-independent colony formation. NT157 effects in vivo were evaluated in a xenograft model of leukemogenesis induced by HEL cells in NSG mice. Statistical analysis was performed using ANOVA or Student\'s t test. In MPN cell lines, NT157 treatment significantly decreased cell viability, clonogenicity and cell proliferation, increased apoptosis and cell cycle arrest in G2/M (all p<0.05). NT157 exposure resulted in inhibition of STAT3, STAT5 and ERK phosphorylation. NT157 also modulated the expression of 23 oncogenes (CCND1, MYB and WT1) and suppressor tumor genes (CDKN1A, FOS and JUN) in HEL cells (p?0.05). In both cell lines, the combined treatment, NT157 plus ruxolitinib, did not potentiate the effects of monotherapies. In primary cells from polycythemia vera patients, NT157 exposition reduced spontaneous erythroid colony formation (all p<0.05). In vivo treatment with vehicle or NT157 (70mg/kg intraperitoneal), three times a week, showed no antineoplastic effects in NSG mice transplanted with HEL cells (n = 5 for each group). In summary, the IRS1/2 pharmacological inhibitor NT157 displayed remarkable antineoplastic effects in JAK2V617F cells lines and MPN primary cells. The combined treatment of NT157 plus ruxolitinib did not present potentializing effects when compared to the monotherapy. The results of in vivo treatment using a xenograft model highlight the need for pharmacokinetic and pharmacodynamic studies for the NT157 compound. The molecular effects identified allowed a better understanding about the mechanisms of NT157 action in MPNs.

The overall objective of this thesis was to examine mechanisms involved in the acute regulation of sarcoplasmic reticulum (SR) Ca2+-handling properties by second messenger signaling pathways in skeletal and cardiac muscle. The aim of the first study (Chapter Two) was to characterize changes in the kinetic properties of sarco(endo)-plasmic reticulum Ca2+-ATPase (SERCA) proteins in cardiac and skeletal muscles in response to b-adrenergic, Ca2+-dependent calmodulin kinase II (CaMKII) and protein kinase C (PKC) signaling. The aim of the second study (Chapter Three) was to determine if insulin signaling could acutely regulate SERCA kinetic properties in cardiac and skeletal muscle. The aim of the final study (Chapter Four) was to determine if alterations in plasma glucose, epinephrine and insulin concentrations during exercise are able to influence SR Ca2+-handling properties in contracting human skeletal muscle. Data collected in Chapter Two and Chapter Three were obtained using tissue prepared from a group of 28 male Sprague-Dawley rats (9 weeks of age; mass = 280 ?? 4 g: X ?? S.E). Crude muscle homogenates (11:1 dilution) were prepared from selected hind limb muscles (soleus, SOL; extensor digitorum longus, EDL; the red portion of gastrocnemius, RG; and the white portion of gastrocnemius, WG) and the left ventricle (LV). Enriched SR membrane fractions, prepared from WG and LV, were also analyzed. A spectrophotometric assay was used to measure kinetic properties of SERCA, namely, maximal SERCA activity (Vmax), and Ca2+-sensitivity was characterized by both the Ca50, which is defined as the free Ca2+-concentration needed to elicit 50% Vmax, and the Hill coefficient (nH), which is defined as the relationship between SERCA activity and Ca2+f for 10 to 90% Vmax. The observations made in Chapter Two indicated that b-adrenergic signaling, activated by epinephrine, increased (P<0.05) Ca2+-sensitivity, as shown by a left-shift in Ca50 (i.e. reduced Ca50), without altering Vmax in LV and SOL but had no effect (P<0.05) on EDL, RG, or WG. Further analysis using a combination of cAMP, the PKA activator forskolin, and/or the PKA inhibitor KT5270 indicated that the reduced Ca50 in LV was activated by cAMP- and PKA-signaling mechanisms. However, although the reduced Ca50 in SOL was cAMP-dependent, it was not influenced by a PKA-dependent mechanism. In contrast to the effects of b-adrenergic signaling, CaMKII activation increased SERCA Ca2+-sensitivity, as shown by a left-shift in Ca50 and increased nh, without altering SERCA Vmax in LV but was without effect in any of the skeletal muscles examined. The PKC activator PMA significantly reduced SERCA Ca2+-sensitivity, by inducing a right-shift in Ca50 and decreased nH in the LV and all skeletal muscles examined. PKC activation also reduced Vmax in the fast-twitch skeletal muscles (i.e. EDL, RG and WG), but did not alter Vmax in LV or SOL. The results of Chapter Three indicated that insulin signaling increased SERCA Ca2+-sensitivity, as shown by a left-shift in Ca50 (i.e. reduced Ca50) and an increased nH, without altering SERCA Vmax in crude muscle homogenates prepared from LV, SOL, EDL, RG, and WG. An increase in SERCA Ca2+-sensitivity was also observed in enriched SERCA1a and SERCA2a vesicles when an activated form of the insulin receptor (A-INS-R) was included during biochemical analyses. Co-immunoprecipitation experiments were conducted and indicated that IRS-1 and IRS-2 proteins bind SERCA1a and SERCA2a in an insulin-dependent manner. However, the binding of IRS proteins with SERCA does not appear to alter the structural integrity of the SERCA Ca2+-binding site since no changes in NCD-4 fluorescence were observed in response to insulin or A-INS-R. Moreover, the increase in SERCA Ca2+-sensitivity due to insulin signaling was not associated with changes in the phosphorylation status of phospholamban (PLN) since Ser16 or Thr17 phosphorylation was not altered by insulin or A-INS-R in LV tissue. The data described in Chapter Four was collected from 15 untrained human participants (peak O2 consumption, VO2peak= 3.45 ?? 0.17 L/min) who completed a standardized cycle test (~60% VO2peak) on two occasions during which they were provided either an artificially sweetened placebo (PLAC) or a 6% glucose (GLUC) beverage (~1.00 g CHO per kg body mass). Muscle biopsies were collected from the vastus lateralis at rest, after 30 min and 90 min of exercise and at fatigue in both conditions to allow assessment of metabolic and SR data. Glucose supplementation increased exercise ride time by ~19% (137 ?? 7 min) compared to PLAC (115 ?? 6 min). This performance increase was associated with elevated plasma glucose and insulin concentrations and reduced catecholamine concentrations during GLUC compared to PLAC. Prolonged exercise reduced (p<0.05) SR Ca2+-uptake, Vmax, Phase 1 and Phase 2 Ca2+-release rates during both PLAC and GLUC. However, no differences in SR Ca2+-handling properties were observed between conditions when direct comparisons were made at matched time points between PLAC and GLUC. In summary, the results of the first study (Chapter Two) indicate that b-adrenergic and CaMKII signaling increases SERCA Ca2+-sensitivity in the LV and SOL; while PKC signaling reduces SERCA Ca2+-sensitivity in all tissues. PKC activation also reduces Vmax in the fast-twitch skeletal muscles (i.e. EDL, RG, and WG) but has no effect on Vmax in the LV and SOL. The results of the second study (Chapter Three) indicate that insulin signaling acutely increases the Ca2+-sensitivity of SERCA1a and SERCA2a in all tissues examined, without altering the Vmax. Based on our observations, it appears that the increase in SERCA Ca2+-sensitivity may be regulated, in part, through the interaction of IRS proteins with SERCA1a and SERCA2a. The results of the final study (Chapter Four) indicate that alterations in plasma glucose, epinephrine and insulin concentrations associated with glucose supplementation during exercise, do not alter the time course or magnitude of reductions in SERCA or Ca2+-release channel (CRC) function in working human skeletal muscle. Although glucose supplementation did increase exercise ride time to fatigue in this study, our data does not reveal an association with SR Ca2+-cycling measured in vitro. It is possible that the strength of exercise signal overrides the hormonal influences observed in resting muscles. Additionally, these data do not rule out the possibility that glucose supplementation may influence E-C coupling processes or SR Ca2+-cycling properties in vivo.

Leucemia mieloide crônica (LMC) é uma neoplasia hematológica maligna associada à atividade tirosinoquinase da oncoproteína BCR-ABL1. A maioria dos casos de LMC é tratada com sucesso com inibidores tirosinoquinase de BCR-ABL1, mas uma porcentagem significativa de pacientes desenvolve resistência ao fármaco. Estudos recentes indicam que a célula-tronco leucêmica é resistente ao tratamento com imatinibe. A identificação de outras proteínas que cooperam com as vias de sinalização BCR-ABL1 podem indicar novos alvos terapêuticos. Os substratos do receptor de insulina (IRS) têm emergido como proteínas importantes na fisiopatologia de neoplasias sólidas e hematológicas. Um inibidor farmacológico de IGF1R-IRS1/2, NT157, foi desenvolvido e mostrou resultados promissores em estudos pré-clínicos com tumores sólidos. A associação constitutiva de IRS1 com BCRABL1 e o efeito antineoplásico resultante do silenciamento espefício de IRS1 em células K562 BCR-ABL1+ suportam a hipótese deste trabalho. O objetivo do presente estudo foi investigar o efeito da inibição farmacológica de IGF1R-IRS1/2 no fenótipo de células hematopoéticas leucêmicas BCR-ABL1+ utilizando células primárias, células K562 e modelos murinos. IRS1, mas não IRS2, apresentou-se menos expresso em amostras de medula óssea de pacientes com diagnóstico de LMC quando comparadas às amostras de células hematopoéticas normais (p<0,0001). NT157 reduziu a formação de colônias de células primárias de pacientes com LMC, mas não de células hematopoéticas de indivíduos saudáveis. Em células K562, o tratamento com o inibidor farmacológico de IGF1R-IRS1/2, NT157, reduziu a viabilidade e proliferação celular e induziu apoptose (p<0,05), inibiu a fosforilação de IGF1R, STAT3, STAT5, 4EBP1, P70S6K e ERK1/2, aumentou a expressão dos genes supressores de tumor CDKN1A, FOS e JUN e reduziu a expressão dos oncogenes MYC e BCL2 (p<0,05); a inibição específica de IRS1 através de lentivírus, mas não de IRS2, reduziu a viabilidade celular (p<0,05). Em células murinas Ba/F3 BCR-ABL1 e BCRABL1T315I, o inibidor farmacológico de IGF1R-IRS1/2, NT157, induziu apoptose e reduziu ativação de ERK1/2 in vitro. Na dose de 50mg/kg/dia, NT157 intraperitoneal e/ou imatinibe por gavagem falharam em reduzir o crescimento tumoral in vivo em modelo de tumor alográfico induzido por células Ba/F3 BCR-ABL1 e BCR-ABL1T315I. Em modelo animal de leucemia induzido por transplante de células hematopoéticas transduzidas com BCR-ABL1: (i) o tratamento com NT157 100mg/kg intraperitoneal, 3 vezes por semana, combinado com imatinibe 100mg/kg/dia por gavagem, reduziu significativamente o peso do baço, e preveniu a perda de peso comparado com veículo (p<0,05); apenas a monoterapia com imatinibe prolongou a sobrevida dos animais, (ii) o tratamento com NT157 70mg/kg intraperitoneal, 3 vezes por semana, e/ou imatinibe 70mg/kg/dia por gavagem não teve impacto no peso do baço e na variação do peso corporal; o tratamento com imatinibe em monoterapia ou combinado com NT157 prolongou a sobrevida dos animais (p<0,05). Em conclusão, o inibidor farmacológico de IGF1R-IRS1/2 representa uma droga potencialmente eficaz no tratamento da LMC, especialmente em casos de resistência com mutação BCR-ABL1 T315I. A avaliação da eficácia do inibidor farmacológico NT157 em modelos animais de LMC exige ajustes nos modelos murinos utilizados no presente estudo, melhor entendimento da farmacodinâmica e farmacocinética do composto e ajustes no esquema terapêutico utilizado. / Chronic myeloid leukemia (CML) is a hematological malignancy associated with the tyrosine kinase activity of the BCR-ABL1 oncoprotein. Most cases of CML are successfully treated with BCR-ABL1 tyrosine kinase inhibitors, but a significant percentage of patients develop resistance. Recent studies indicate that leukemic stem cell is resistant to imatinib treatment. The identification of other proteins that cooperate with the BCR-ABL1 signaling pathway may indicate novel therapeutic targets. Insulin receptor substrates (IRS) have emerged as important proteins in the pathophysiology of solid and hematological neoplasms. A pharmacological inhibitor of IGF1R-IRS1/2, NT157, has been developed and shown promising results in preclinical studies with solid tumors. The constitutive association of IRS1 with BCR-ABL1, and the antineoplastic effects resulting from IRS1-specific silencing in K562 BCR-ABL1+ cells, support the hypothesis of this work. The aim of the present study was to investigate the effect of pharmacological inhibition of IGF1R-IRS1/2 on the phenotype of BCR-ABL1+ leukemia cells, using primary cells, K562 cell line and murine models. IRS1, but not IRS2, was downregulated in bone marrow samples from CML patients compared to bone marrow cells from healthy donors (p<0.0001). NT157 reduced colony formation of primary cells from CML patients but not from healthy donors. In K562 cells, treatment with the pharmacological inhibitor IGF1R-IRS1/2, NT157, reduced cell viability and proliferation, induced apoptosis (p<0.05), inhibited the phosphorylation of IGF1R, STAT3, STAT5, 4EBP1, P70S6K and ERK1/2, increased expression of tumor suppressor genes CDKN1A, FOS and JUN, and reduced expression of oncogenes MYC and BCL2 (p<0.05); IRS1 silencing mediated by lentivirus, but not IRS2, reduced cell viability (p<0.05). In murine Ba/F3 BCRABL1 and Ba/F3 BCR-ABL1T315I cells, the pharmacological inhibitor of IGF1R-IRS1/2, NT157, induced apoptosis and reduced ERK1/2 activation in vitro. At 50mg/kg/day, NT157 intraperitoneally and/or imatinib orally, failed to reduce tumor burden in vivo in an allographic tumor model induced by Ba/F3 BCR-ABL1 and Ba/F3 BCR-ABL1T315I cells . In an animal leukemia model induced by transplantation of BCR-ABL1-transduced hematopoietic cells : (i) treatment with NT157 100mg/kg intraperitoneally, 3 times per week, combined with imatinib 100mg/kg/day per gavage, significantly reduced spleen weight, and prevented weight loss compared to vehicle (p<0.05); only imatinib monotherapy prolonged survival (p<0.05), (ii) treatment with NT157 70 mg/kg intraperitoneally, 3 times per week, and/or imatinib 70 mg/kg/day per gavage had no impact on spleen weight and body weight; treatment with imatinib alone or combined with NT157 prolonged survival (p<0.05). In conclusion, the pharmacological inhibitor of IGF1R-IRS1/2 represents a potential effective drug in CML therapy, especially in cases of resistant BCR-ABL1 T315I mutation. The evaluation of the NT157 pharmacological efficacy in CML animal models requires adjustments in the murine models used in the present study, better understanding of the pharmacodynamics and pharmacokinetics of the compound and adjustments in the therapeutic scheme used.

Leucemia mieloide crônica (LMC) é uma neoplasia hematológica maligna associada à atividade tirosinoquinase da oncoproteína BCR-ABL1. A maioria dos casos de LMC é tratada com sucesso com inibidores tirosinoquinase de BCR-ABL1, mas uma porcentagem significativa de pacientes desenvolve resistência ao fármaco. Estudos recentes indicam que a célula-tronco leucêmica é resistente ao tratamento com imatinibe. A identificação de outras proteínas que cooperam com as vias de sinalização BCR-ABL1 podem indicar novos alvos terapêuticos. Os substratos do receptor de insulina (IRS) têm emergido como proteínas importantes na fisiopatologia de neoplasias sólidas e hematológicas. Um inibidor farmacológico de IGF1R-IRS1/2, NT157, foi desenvolvido e mostrou resultados promissores em estudos pré-clínicos com tumores sólidos. A associação constitutiva de IRS1 com BCRABL1 e o efeito antineoplásico resultante do silenciamento espefício de IRS1 em células K562 BCR-ABL1+ suportam a hipótese deste trabalho. O objetivo do presente estudo foi investigar o efeito da inibição farmacológica de IGF1R-IRS1/2 no fenótipo de células hematopoéticas leucêmicas BCR-ABL1+ utilizando células primárias, células K562 e modelos murinos. IRS1, mas não IRS2, apresentou-se menos expresso em amostras de medula óssea de pacientes com diagnóstico de LMC quando comparadas às amostras de células hematopoéticas normais (p<0,0001). NT157 reduziu a formação de colônias de células primárias de pacientes com LMC, mas não de células hematopoéticas de indivíduos saudáveis. Em células K562, o tratamento com o inibidor farmacológico de IGF1R-IRS1/2, NT157, reduziu a viabilidade e proliferação celular e induziu apoptose (p<0,05), inibiu a fosforilação de IGF1R, STAT3, STAT5, 4EBP1, P70S6K e ERK1/2, aumentou a expressão dos genes supressores de tumor CDKN1A, FOS e JUN e reduziu a expressão dos oncogenes MYC e BCL2 (p<0,05); a inibição específica de IRS1 através de lentivírus, mas não de IRS2, reduziu a viabilidade celular (p<0,05). Em células murinas Ba/F3 BCR-ABL1 e BCRABL1T315I, o inibidor farmacológico de IGF1R-IRS1/2, NT157, induziu apoptose e reduziu ativação de ERK1/2 in vitro. Na dose de 50mg/kg/dia, NT157 intraperitoneal e/ou imatinibe por gavagem falharam em reduzir o crescimento tumoral in vivo em modelo de tumor alográfico induzido por células Ba/F3 BCR-ABL1 e BCR-ABL1T315I. Em modelo animal de leucemia induzido por transplante de células hematopoéticas transduzidas com BCR-ABL1: (i) o tratamento com NT157 100mg/kg intraperitoneal, 3 vezes por semana, combinado com imatinibe 100mg/kg/dia por gavagem, reduziu significativamente o peso do baço, e preveniu a perda de peso comparado com veículo (p<0,05); apenas a monoterapia com imatinibe prolongou a sobrevida dos animais, (ii) o tratamento com NT157 70mg/kg intraperitoneal, 3 vezes por semana, e/ou imatinibe 70mg/kg/dia por gavagem não teve impacto no peso do baço e na variação do peso corporal; o tratamento com imatinibe em monoterapia ou combinado com NT157 prolongou a sobrevida dos animais (p<0,05). Em conclusão, o inibidor farmacológico de IGF1R-IRS1/2 representa uma droga potencialmente eficaz no tratamento da LMC, especialmente em casos de resistência com mutação BCR-ABL1 T315I. A avaliação da eficácia do inibidor farmacológico NT157 em modelos animais de LMC exige ajustes nos modelos murinos utilizados no presente estudo, melhor entendimento da farmacodinâmica e farmacocinética do composto e ajustes no esquema terapêutico utilizado. / Chronic myeloid leukemia (CML) is a hematological malignancy associated with the tyrosine kinase activity of the BCR-ABL1 oncoprotein. Most cases of CML are successfully treated with BCR-ABL1 tyrosine kinase inhibitors, but a significant percentage of patients develop resistance. Recent studies indicate that leukemic stem cell is resistant to imatinib treatment. The identification of other proteins that cooperate with the BCR-ABL1 signaling pathway may indicate novel therapeutic targets. Insulin receptor substrates (IRS) have emerged as important proteins in the pathophysiology of solid and hematological neoplasms. A pharmacological inhibitor of IGF1R-IRS1/2, NT157, has been developed and shown promising results in preclinical studies with solid tumors. The constitutive association of IRS1 with BCR-ABL1, and the antineoplastic effects resulting from IRS1-specific silencing in K562 BCR-ABL1+ cells, support the hypothesis of this work. The aim of the present study was to investigate the effect of pharmacological inhibition of IGF1R-IRS1/2 on the phenotype of BCR-ABL1+ leukemia cells, using primary cells, K562 cell line and murine models. IRS1, but not IRS2, was downregulated in bone marrow samples from CML patients compared to bone marrow cells from healthy donors (p<0.0001). NT157 reduced colony formation of primary cells from CML patients but not from healthy donors. In K562 cells, treatment with the pharmacological inhibitor IGF1R-IRS1/2, NT157, reduced cell viability and proliferation, induced apoptosis (p<0.05), inhibited the phosphorylation of IGF1R, STAT3, STAT5, 4EBP1, P70S6K and ERK1/2, increased expression of tumor suppressor genes CDKN1A, FOS and JUN, and reduced expression of oncogenes MYC and BCL2 (p<0.05); IRS1 silencing mediated by lentivirus, but not IRS2, reduced cell viability (p<0.05). In murine Ba/F3 BCRABL1 and Ba/F3 BCR-ABL1T315I cells, the pharmacological inhibitor of IGF1R-IRS1/2, NT157, induced apoptosis and reduced ERK1/2 activation in vitro. At 50mg/kg/day, NT157 intraperitoneally and/or imatinib orally, failed to reduce tumor burden in vivo in an allographic tumor model induced by Ba/F3 BCR-ABL1 and Ba/F3 BCR-ABL1T315I cells . In an animal leukemia model induced by transplantation of BCR-ABL1-transduced hematopoietic cells : (i) treatment with NT157 100mg/kg intraperitoneally, 3 times per week, combined with imatinib 100mg/kg/day per gavage, significantly reduced spleen weight, and prevented weight loss compared to vehicle (p<0.05); only imatinib monotherapy prolonged survival (p<0.05), (ii) treatment with NT157 70 mg/kg intraperitoneally, 3 times per week, and/or imatinib 70 mg/kg/day per gavage had no impact on spleen weight and body weight; treatment with imatinib alone or combined with NT157 prolonged survival (p<0.05). In conclusion, the pharmacological inhibitor of IGF1R-IRS1/2 represents a potential effective drug in CML therapy, especially in cases of resistant BCR-ABL1 T315I mutation. The evaluation of the NT157 pharmacological efficacy in CML animal models requires adjustments in the murine models used in the present study, better understanding of the pharmacodynamics and pharmacokinetics of the compound and adjustments in the therapeutic scheme used.

The overall objective of this thesis was to examine mechanisms involved in the acute regulation of sarcoplasmic reticulum (SR) Ca2+-handling properties by second messenger signaling pathways in skeletal and cardiac muscle. The aim of the first study (Chapter Two) was to characterize changes in the kinetic properties of sarco(endo)-plasmic reticulum Ca2+-ATPase (SERCA) proteins in cardiac and skeletal muscles in response to b-adrenergic, Ca2+-dependent calmodulin kinase II (CaMKII) and protein kinase C (PKC) signaling. The aim of the second study (Chapter Three) was to determine if insulin signaling could acutely regulate SERCA kinetic properties in cardiac and skeletal muscle. The aim of the final study (Chapter Four) was to determine if alterations in plasma glucose, epinephrine and insulin concentrations during exercise are able to influence SR Ca2+-handling properties in contracting human skeletal muscle. Data collected in Chapter Two and Chapter Three were obtained using tissue prepared from a group of 28 male Sprague-Dawley rats (9 weeks of age; mass = 280 ± 4 g: X ± S.E). Crude muscle homogenates (11:1 dilution) were prepared from selected hind limb muscles (soleus, SOL; extensor digitorum longus, EDL; the red portion of gastrocnemius, RG; and the white portion of gastrocnemius, WG) and the left ventricle (LV). Enriched SR membrane fractions, prepared from WG and LV, were also analyzed. A spectrophotometric assay was used to measure kinetic properties of SERCA, namely, maximal SERCA activity (Vmax), and Ca2+-sensitivity was characterized by both the Ca50, which is defined as the free Ca2+-concentration needed to elicit 50% Vmax, and the Hill coefficient (nH), which is defined as the relationship between SERCA activity and Ca2+f for 10 to 90% Vmax. The observations made in Chapter Two indicated that b-adrenergic signaling, activated by epinephrine, increased (P<0.05) Ca2+-sensitivity, as shown by a left-shift in Ca50 (i.e. reduced Ca50), without altering Vmax in LV and SOL but had no effect (P<0.05) on EDL, RG, or WG. Further analysis using a combination of cAMP, the PKA activator forskolin, and/or the PKA inhibitor KT5270 indicated that the reduced Ca50 in LV was activated by cAMP- and PKA-signaling mechanisms. However, although the reduced Ca50 in SOL was cAMP-dependent, it was not influenced by a PKA-dependent mechanism. In contrast to the effects of b-adrenergic signaling, CaMKII activation increased SERCA Ca2+-sensitivity, as shown by a left-shift in Ca50 and increased nh, without altering SERCA Vmax in LV but was without effect in any of the skeletal muscles examined. The PKC activator PMA significantly reduced SERCA Ca2+-sensitivity, by inducing a right-shift in Ca50 and decreased nH in the LV and all skeletal muscles examined. PKC activation also reduced Vmax in the fast-twitch skeletal muscles (i.e. EDL, RG and WG), but did not alter Vmax in LV or SOL. The results of Chapter Three indicated that insulin signaling increased SERCA Ca2+-sensitivity, as shown by a left-shift in Ca50 (i.e. reduced Ca50) and an increased nH, without altering SERCA Vmax in crude muscle homogenates prepared from LV, SOL, EDL, RG, and WG. An increase in SERCA Ca2+-sensitivity was also observed in enriched SERCA1a and SERCA2a vesicles when an activated form of the insulin receptor (A-INS-R) was included during biochemical analyses. Co-immunoprecipitation experiments were conducted and indicated that IRS-1 and IRS-2 proteins bind SERCA1a and SERCA2a in an insulin-dependent manner. However, the binding of IRS proteins with SERCA does not appear to alter the structural integrity of the SERCA Ca2+-binding site since no changes in NCD-4 fluorescence were observed in response to insulin or A-INS-R. Moreover, the increase in SERCA Ca2+-sensitivity due to insulin signaling was not associated with changes in the phosphorylation status of phospholamban (PLN) since Ser16 or Thr17 phosphorylation was not altered by insulin or A-INS-R in LV tissue. The data described in Chapter Four was collected from 15 untrained human participants (peak O2 consumption, VO2peak= 3.45 ± 0.17 L/min) who completed a standardized cycle test (~60% VO2peak) on two occasions during which they were provided either an artificially sweetened placebo (PLAC) or a 6% glucose (GLUC) beverage (~1.00 g CHO per kg body mass). Muscle biopsies were collected from the vastus lateralis at rest, after 30 min and 90 min of exercise and at fatigue in both conditions to allow assessment of metabolic and SR data. Glucose supplementation increased exercise ride time by ~19% (137 ± 7 min) compared to PLAC (115 ± 6 min). This performance increase was associated with elevated plasma glucose and insulin concentrations and reduced catecholamine concentrations during GLUC compared to PLAC. Prolonged exercise reduced (p<0.05) SR Ca2+-uptake, Vmax, Phase 1 and Phase 2 Ca2+-release rates during both PLAC and GLUC. However, no differences in SR Ca2+-handling properties were observed between conditions when direct comparisons were made at matched time points between PLAC and GLUC. In summary, the results of the first study (Chapter Two) indicate that b-adrenergic and CaMKII signaling increases SERCA Ca2+-sensitivity in the LV and SOL; while PKC signaling reduces SERCA Ca2+-sensitivity in all tissues. PKC activation also reduces Vmax in the fast-twitch skeletal muscles (i.e. EDL, RG, and WG) but has no effect on Vmax in the LV and SOL. The results of the second study (Chapter Three) indicate that insulin signaling acutely increases the Ca2+-sensitivity of SERCA1a and SERCA2a in all tissues examined, without altering the Vmax. Based on our observations, it appears that the increase in SERCA Ca2+-sensitivity may be regulated, in part, through the interaction of IRS proteins with SERCA1a and SERCA2a. The results of the final study (Chapter Four) indicate that alterations in plasma glucose, epinephrine and insulin concentrations associated with glucose supplementation during exercise, do not alter the time course or magnitude of reductions in SERCA or Ca2+-release channel (CRC) function in working human skeletal muscle. Although glucose supplementation did increase exercise ride time to fatigue in this study, our data does not reveal an association with SR Ca2+-cycling measured in vitro. It is possible that the strength of exercise signal overrides the hormonal influences observed in resting muscles. Additionally, these data do not rule out the possibility that glucose supplementation may influence E-C coupling processes or SR Ca2+-cycling properties in vivo.

Numa primeira etapa, estudamos as conexões da VTA para o complexo VTA-substância negra (SN) utilizando a leucoaglutinina do Phaseolus vulgaris (PHA-L). Estas conexões são substanciais, topograficamente organizadas, com destaque para o pólo caudal da VTA que inerva bilateralmente toda a extensão deste complexo. Numa segunda etapa, estudamos as projeções da VTA para o hipotálamo. A VTA se projeta principalmente para a área pré-óptica lateral e área hipotalâmica lateral, a região subfornical posterior e o núcleo dorsomedial. Foram vistas poucas aposições entre varicosidades PHA-L+ e neurônios imunorreativos para orexina ou para hormônio concentrador de melanina. Por fim, estudamos a colocalização do substrato do receptor de insulina (IRS-1), IRS-1 fosforilado e fosfatidilinositol-3 quinase (PI3K) com tirosina hidroxilase (TH) ou com a subunidade B da toxina colérica (CTb) injetada no estriado. A maioria dos neurônios TH+ da VTA-SN expressa IRS-1; injeções de CTb no estriado resultaram em células duplamente marcadas para CTb/IRS-1, CTb/PI3K e CTb/IRS-1 fosforilado. / In a first step, we studied the connections of the VTA to the complex VTA-substantia nigra (SN) using the Phaseolus vulgaris leucoagglutinin (PHA-L). These connections are substantial, topographically organized, especially the caudal pole of the VTA, which innervates bilaterally throughout the length of this complex. In a second step, we studied the projections of the VTA to the hypothalamus. The VTA projected mainly to the lateral preoptic area, lateral hypothalamic area, posterior subfornical region and dorsomedial nucleus. Were observed few appositions between PHA-L+ varicosities and neurons immunoreactive for orexin or melanin-concentrating hormone. Finally, we studied the co-localization of the insulin receptor substrate-1 (IRS-1), IRS-1-phosphorylated and phosphatidylinositol-3 kinase (PI3K) with tyrosine hydroxylase (TH) or cholera toxin B subunit (CTb) injected into the striatum. Most TH+ neurons of the VTA-SN expressed IRS-1; CTb injections in the striatum resulted in cells double-labeled for CTb/IRS-1, CTb/PI3K and CTb/IRS-1 phosphorylated.

Numa primeira etapa, estudamos as conexões da VTA para o complexo VTA-substância negra (SN) utilizando a leucoaglutinina do Phaseolus vulgaris (PHA-L). Estas conexões são substanciais, topograficamente organizadas, com destaque para o pólo caudal da VTA que inerva bilateralmente toda a extensão deste complexo. Numa segunda etapa, estudamos as projeções da VTA para o hipotálamo. A VTA se projeta principalmente para a área pré-óptica lateral e área hipotalâmica lateral, a região subfornical posterior e o núcleo dorsomedial. Foram vistas poucas aposições entre varicosidades PHA-L+ e neurônios imunorreativos para orexina ou para hormônio concentrador de melanina. Por fim, estudamos a colocalização do substrato do receptor de insulina (IRS-1), IRS-1 fosforilado e fosfatidilinositol-3 quinase (PI3K) com tirosina hidroxilase (TH) ou com a subunidade B da toxina colérica (CTb) injetada no estriado. A maioria dos neurônios TH+ da VTA-SN expressa IRS-1; injeções de CTb no estriado resultaram em células duplamente marcadas para CTb/IRS-1, CTb/PI3K e CTb/IRS-1 fosforilado. / In a first step, we studied the connections of the VTA to the complex VTA-substantia nigra (SN) using the Phaseolus vulgaris leucoagglutinin (PHA-L). These connections are substantial, topographically organized, especially the caudal pole of the VTA, which innervates bilaterally throughout the length of this complex. In a second step, we studied the projections of the VTA to the hypothalamus. The VTA projected mainly to the lateral preoptic area, lateral hypothalamic area, posterior subfornical region and dorsomedial nucleus. Were observed few appositions between PHA-L+ varicosities and neurons immunoreactive for orexin or melanin-concentrating hormone. Finally, we studied the co-localization of the insulin receptor substrate-1 (IRS-1), IRS-1-phosphorylated and phosphatidylinositol-3 kinase (PI3K) with tyrosine hydroxylase (TH) or cholera toxin B subunit (CTb) injected into the striatum. Most TH+ neurons of the VTA-SN expressed IRS-1; CTb injections in the striatum resulted in cells double-labeled for CTb/IRS-1, CTb/PI3K and CTb/IRS-1 phosphorylated.